<?php

	$this->Html->script(array('jquery.maskedinput-1.2.2.min','maskinput','jquery.ui.datepicker-pt-BR','datepicker'), false);

	$paciente_id = $this->request->data['PacienteConvenio']['paciente_id'];

	echo "<fieldset><legend>$nome_paciente :: Convênios</legend>";
	echo $this->Form->create('PacienteConvenio');
	echo $this->Form->input('id');
	echo $this->Form->input('paciente_id',array('type' => 'hidden'));
	echo $this->Form->input('convenio_id',array('type' => 'select', 'options' => $convenios, 'empty' => 'Selecione...', 'class' => 'tamanho50', 'label' => __('Convênio')));
	echo $this->Form->input('numero_cartao',array('type'=>'text', 'class' => 'tamanho20', 'label'=> __('No. Cartão'), 'maxlength'=>20));
	echo $this->Form->input('plano',array('type'=>'text', 'class' => 'tamanho30', 'label'=> __('Plano'), 'maxlength' => 50));
	echo $this->Form->input('data_validade', array('label' => __('Dt Validade'), 'type' => 'text', 'class' => 'maskdata data'));
	echo $this->Form->input('abrangencia',array('type'=>'text', 'class' => 'tamanho30', 'label'=> __('Abrangência'), 'maxlength' => 50));
	echo $this->Form->input('ativo',array('type' => 'select', 'options' => $sim_nao, 'label' => __('Ativo')));

	echo '<div class="botoes_form">';
	echo $this->Form->button('Salvar', array('type' => 'submit'));
	echo $this->Form->button('Voltar', array('type'=>'button', 'onClick' => "javascript:location='{$this->request->base}/pacientes/alterar/$paciente_id'"));
	echo '</div>'; 
	echo $this->Form->end();
	echo '</fieldset>';